TUBAL REVERSAL BY MICROSURGERY
Tubal ligation is used very commonly as a form of contraception in the United States. When life circumstances change often the question of whether this procedure is reversible comes up. Fortunately with modern microsurgical techniques, the answer most often is that it can be reversed.
Tubal ligation can be performed by a variety of techniques Some of the more common methods include the Pomeroy technique, frequently employed on the first day after delivering a baby, or interval sterilization, frequently performed through the laparoscope remote from child bearing. Several different laparoscopic techniques may be used for laparoscopic sterilization. These include cautery (burning of the tubes), rings or clips to occlude the tubes, or cutting or removing portions of the tubes. All of these methods are intended to provide permanent methods of contraception.
However, life circumstances change for many of our patients, and many women desire to regain their fertility after having a previous tubal sterilization performed. Fortunately, the new technique of microscopic tubal reanastomosis (sterilization reversal) is a highly successful surgical procedure. Other alternatives to surgical reanastomosis include in vitro fertilization. Both of these techniques have distinct advantages and disadvantages with overall relatively similar success rates.
Cumulative pregnancy rates over 1-2 years following sterilization reversal often approximate 60%-70%. However, the range of pregnancy rates may vary from 20%-95%. There are multiple factors influencing the outcome of the procedure. Of these, the length of healthy fallopian tube left to be repaired following sterilization reversal is the single most important factor. Success rates are very acceptable when 4-6cms of tube are left When less than 4cms of undamaged tube remain at the end of microsurgery, success rates fall dramatically. Patients at risk for short tubal length are primarily those in which either large segments of tube were removed or in which "multiple burn" cautery technique was utilized for sterilization. Those with the best prognosis are usually women who have clips or rings placed on their tubes or postpartum tubal ligations performed.
Most surgeons performing microsurgical tubal reanastomosis will do so through a mini-laparotomy incision. Most patients require a 1 to 2 night hospital stay following tubal reanastomosis:
During the course of a microsurgical tubal reanastomosis, the fallopian tubes are brought into the incision. The damaged or scarred portions of the fallopian tubes are removed. Then, using 8-0 suture the healthy segments of tube are stitched back together under the microscope. This is usually accomplished in two layers. At the completion of the operation, patency of the fallopian tubes is confirmed by injecting dye through the uterus out the fallopian tubes. Patency rates are greater than 80% in most instances. Unfortunately, due to previous scar tissue from the sterilization procedure or due to scar tissue which may result from the reanastomosis procedure, open tubes do not always function normally.
Other significant factors, which may effect the outcome of tubal reanastomosis, include the age of the female partner, the ovulatory status of the female partner, as well as the reproductive history and sperm function of the male partner. Prior to having tubal reanastomosis performed, your surgeon may perform laboratory testing to confirm the "ovarian reserve" or ovulatory status of the female partner. In addition most surgeons will require a semen analysis on the male partner to confirm that live sperm are present prior to putting the female partner through a relatively lengthy operation. Many couples will conceive quickly after tubal reanastomosis, but the full benefit of the surgery may not be recognized for 1-2 years of attempted conception. In the event that tubal reanastomosis fails to achieve pregnancy, in vitro fertilization may still be an option for many couples. One advantage of reversal over IVF is that it results in fewer multiples. This is often a major issue for the patient who is s/p sterilization and commonly has other children.
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